Secondary and tertiary gain and the dysfunctional family

Sometimes people who have BPD endure a process called Secondary gain. Secondary gain is something that motivates a person externally to engage in specific types of behaviour. It is usually resorted to when a person wants to avoid something, i.e. having to go out to a job, or having to do chores around the house. So, for example the person might say they can’t walk and therefore can not get up and out to go and take the bus to get to work, or they have a severe stomach ache and therefore can not do their assigned chores. For people with BPD this can also be referred to as something called a secondary handicap and this can lead to something called learned helplessness.

People who have BPD are made not born. No one is born with Borderline Personality Disorder. They learn the characteristics and take on the characteristics of the illness through learned behaviour. My opinion is that BPD starts to percolate very early on, sometimes as early as the age of two when a child has a tantrum which is not addressed properly by his or her parents. The child learns essentially that kicking their legs and screaming will get their parents to give in. Their parents reward this bad behaviour and set up a lifetime of tantrums which only grow worse over time. Of course, Borderline Personality Disorder is not that simple but I believe its roots are in childhood tantrums.

Though parents may scapegoat their child with Borderline Personality Disorder, this is very much a family problem and a family issue. Even though BPD affects the person profoundly it also needs to be addressed as a family issue with family therapy.

Dysfunctional families operate with very complex rules. Each person in the family has a role or a function. One person might be designated as the “problem” person or the “sick” person, the mother might take on the role of “caretaker”, the father might have the role of “disciplinarian”. If you think of this family unit as a mobile like you might see above a baby’s crib, you will see that they circle round and round each other but never interact directly with each other.

A mother who acts in the role of the “caretaker” might be deriving what is called tertiary gain because she earns the sympathy of friends and other family members for having to look after that poor, sick girl. My husband basked in the warmth of tertiary gain for years because he “took care of poor, sick me”. The people in my community regarded him a Saint George because of how he looked after me. He had a lot invested in that role and so it was in his best interest to make sure that I stayed sick.

Going back to the analogy of the mobile, when the person with BPD starts to get better with therapy and other interventional efforts, it is as if a hand has reached out and given the mobile a tweak. All the other parts start to shake and gyrate as it tries desperately to regain its equilibrium. This settles over time as long as the tweaking stops. This shaking and gyrating in families is what can sometimes lead a person with BPD to abandon their therapy. They have too much invested in their family unit remaining the same because even something negative is worth keeping if it is familiar.